Does Anthem Cover Jardiance

Discover why Anthem may deny Jardiance, tips for securing coverage, costs without insurance, and answers to FAQs in our comprehensive guide.
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Does Anthem Cover Jardiance?

 

  • Anthem may cover Jardiance, a medication used to manage type 2 diabetes, as part of their prescription drug plan. Coverage depends on the specific plan and policy terms.
  •  

  • Patients typically need a doctor’s prescription for Jardiance, and it may require prior authorization to confirm medical necessity.
  •  

  • Following the plan’s formulary guidelines, ensuring Jardiance is listed, is crucial to determining coverage. If out-of-pocket costs are a concern, checking for any potential generic alternatives might be helpful.
  •  

  • Patients should consult directly with Anthem customer service or their healthcare provider to understand the detailed terms, copays, or deductibles applicable to their specific plan.

 

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Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Jardiance Coverage with Anthem

 

Initial Steps

 

  • Contact your healthcare provider to confirm the medical necessity of Jardiance for your condition. You will need a prescription from your doctor to begin the process.
  •  

  • Review your current Anthem insurance policy to understand what diabetes medications, specifically Jardiance, are covered and the requirements for coverage.

 

Consult with Anthem

 

  • Call the customer service number on the back of your insurance card to speak with an Anthem representative. Inquire specifically about Joaquin coverage options and requirements.
  •  

  • Ask if pre-authorization is needed for coinciding Jardiance. If required, get details on the procedure to secure it and any necessary documentation.

 

Check Anthem’s Preferred Drug List

 

  • Access Anthem's preferred drug list, usually available on their website, to confirm that Jardiance is listed. This list helps determine which medications are covered.
  •  

  • If Jardiance is not listed, inquire about alternatives or the process for obtaining coverage for non-formulary medications.

 

Work with Your Healthcare Provider

 

  • Have your doctor submit any required documentation to Anthem, including medical records and any pre-authorization forms if necessary.
  •  

  • Your healthcare provider may need to write a letter of medical necessity to demonstrate why Jardiance is crucial for your treatment plan.

 

Submit a Claim

 

  • Once you have all necessary documents and approvals from Anthem, submit a claim for Jardiance coverage following Anthem's claim submission process.
  •  

  • Ensure that you understand and comply with Anthem’s claims processing timelines and requirements to avoid delays.

 

Follow-Up

 

  • Monitor the status of your claim regularly by logging into your Anthem online account or contacting their customer service.
  •  

  • If your claim is denied, understand the appeals process. Gather additional documentation if needed and resubmit the appeal promptly.

 

Review Co-Pay Assistance Programs

 

  • Investigate Jardiance co-pay assistance programs, often provided by the manufacturer, to help manage out-of-pocket costs.
  •  

  • Check if Anthem offers any additional savings programs or partnerships that could further reduce medication costs.

 

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FAQs

Does Anthem Cover Jardiance

Discover why Anthem may deny Jardiance, tips for securing coverage, costs without insurance, and answers to FAQs in our comprehensive guide.
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Is Jardiance Covered by Anthem

 

Does Anthem Cover Jardiance?

 

  • Anthem may cover Jardiance, a medication used to manage type 2 diabetes, as part of their prescription drug plan. Coverage depends on the specific plan and policy terms.
  •  

  • Patients typically need a doctor’s prescription for Jardiance, and it may require prior authorization to confirm medical necessity.
  •  

  • Following the plan’s formulary guidelines, ensuring Jardiance is listed, is crucial to determining coverage. If out-of-pocket costs are a concern, checking for any potential generic alternatives might be helpful.
  •  

  • Patients should consult directly with Anthem customer service or their healthcare provider to understand the detailed terms, copays, or deductibles applicable to their specific plan.

 

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Anthem's Approved Criteria for Jardiance Coverage

 

Eligibility Criteria for Jardiance Coverage

 

  • Patient must have a confirmed diagnosis of type 2 diabetes mellitus (T2DM).
  •  

  • Jardiance must be prescribed as an adjunct to diet and exercise to improve glycemic control in individuals with T2DM.
  •  

  • Consideration for approval includes the presence of established cardiovascular disease, or risk of cardiovascular death or heart failure.

 

Prior Treatment Requirement

 

  • Patients should have tried and not achieved adequate glycemic control with a lifestyle modification program and at least one other oral antihyperglycemic medication, such as metformin.

 

Renal Function Assessment

 

  • Coverage consideration requires documentation of a recent renal function assessment. Gartiance may not be recommended for individuals with specific renal conditions as stipulated by the prescribing information.

 

Age Consideration

 

  • Jardiance is approved for use in eligible adult patients aged 18 years and older.

 

Dosage and Administration

 

  • Initial approval for coverage is based on adherence to the FDA-approved dosing regimen. Further dosage adjustments must be supported by clinical justification and monitoring.

 

Documentation Requirements

 

  • Healthcare providers must submit comprehensive medical records illustrating the necessity of Jardiance therapy, patient clinical history, and previously tried treatments and outcomes.

 

Continued Coverage Criteria

 

  • For continued coverage, the patient's response to therapy must be documented for effectiveness and safety. This may include A1C levels, occurrence of any adverse effects, and overall health improvement.

 

Why Anthem Might Deny Jardiance Coverage

 

Reasons Anthem Might Deny Jardiance Coverage

 

  • **Non-Approved Medical Use**: Jardiance may be denied if it is prescribed for conditions not approved by health authorities or off-label uses not covered in your policy.
  •  

  • **Lack of Prior Authorization**: Coverage may be denied if prior authorization was not obtained, meaning that Anthem did not receive the necessary documentation to approve Jardiance before it was prescribed.
  •  

  • **Step Therapy Requirements**: Jardiance might not be covered if the patient has not tried other less expensive medications first, as Anthem may have a step therapy policy in place requiring this process.
  •  

  • **Policy Exclusion**: There might be specific policy exclusions that list Jardiance as a non-covered medication, especially if it is considered a non-essential or experimental treatment under the terms of the plan.
  •  

  • **Non-Compliance with Formulary Guidelines**: If Jardiance is not included in the formulary, or the specific tier it occupies is not covered by the patient's plan, Anthem may deny coverage.
  •  

  • **Inadequate Documentation of Medical Necessity**: If there's insufficient documentation or rationale for prescribing Jardiance over other options, Anthem might deny coverage on the basis of lacking evidence of necessity.

 

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How Much Does Jardiance Cost without Insurance?

 

Estimated Cost of Jardiance Without Insurance

 

  • The cost of Jardiance can vary depending on the pharmacy you visit, but as an oral medication used primarily to treat type 2 diabetes, it is often priced at a premium. Without insurance, the average monthly cost is approximately $550 to $650 for a 30-day supply of 10 mg or 25 mg tablets.
  •  

  • Prices can also vary based on location, pharmacy discounts, and available manufacturer coupons, so it's advisable to shop around or look for any available patient assistance programs to potentially lower the out-of-pocket cost.

 

Ways to Lower the Cost of Jardiance

 

  • **Pharmacy Discount Cards:** Utilizing pharmacy discount cards can sometimes provide substantial savings on your prescription, reducing the price by a notable percentage.
  •  

  • **Manufacturer Coupons and Programs:** Eli Lilly, the manufacturer of Jardiance, may offer savings cards or assistance programs to help eligible patients reduce their costs. It's worth checking through their official website or consulting with your healthcare provider.
  •  

  • **Generic Alternatives:** Although there may not be a generic version of Jardiance available currently, consulting with your healthcare provider about other generic medications for your condition may offer a more budget-friendly option.
  •  

  • **Bulk Purchasing Options:** Some pharmacies might offer discounts for purchasing a 90-day supply instead of a 30-day supply, which can lead to savings in the long term.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Jardiance Coverage with Anthem

 

Initial Steps

 

  • Contact your healthcare provider to confirm the medical necessity of Jardiance for your condition. You will need a prescription from your doctor to begin the process.
  •  

  • Review your current Anthem insurance policy to understand what diabetes medications, specifically Jardiance, are covered and the requirements for coverage.

 

Consult with Anthem

 

  • Call the customer service number on the back of your insurance card to speak with an Anthem representative. Inquire specifically about Joaquin coverage options and requirements.
  •  

  • Ask if pre-authorization is needed for coinciding Jardiance. If required, get details on the procedure to secure it and any necessary documentation.

 

Check Anthem’s Preferred Drug List

 

  • Access Anthem's preferred drug list, usually available on their website, to confirm that Jardiance is listed. This list helps determine which medications are covered.
  •  

  • If Jardiance is not listed, inquire about alternatives or the process for obtaining coverage for non-formulary medications.

 

Work with Your Healthcare Provider

 

  • Have your doctor submit any required documentation to Anthem, including medical records and any pre-authorization forms if necessary.
  •  

  • Your healthcare provider may need to write a letter of medical necessity to demonstrate why Jardiance is crucial for your treatment plan.

 

Submit a Claim

 

  • Once you have all necessary documents and approvals from Anthem, submit a claim for Jardiance coverage following Anthem's claim submission process.
  •  

  • Ensure that you understand and comply with Anthem’s claims processing timelines and requirements to avoid delays.

 

Follow-Up

 

  • Monitor the status of your claim regularly by logging into your Anthem online account or contacting their customer service.
  •  

  • If your claim is denied, understand the appeals process. Gather additional documentation if needed and resubmit the appeal promptly.

 

Review Co-Pay Assistance Programs

 

  • Investigate Jardiance co-pay assistance programs, often provided by the manufacturer, to help manage out-of-pocket costs.
  •  

  • Check if Anthem offers any additional savings programs or partnerships that could further reduce medication costs.

 

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Jardiance FAQ

What is Jardiance used for?

 

What is Jardiance Used For?

 

  • Jardiance is primarily used to manage type 2 diabetes by helping to lower blood sugar levels in adults.
  •  

  • It works by promoting the excretion of excess glucose through urine, thus reducing the amount of sugar the body absorbs.
  •  

  • In addition to blood sugar management, Jardiance is also prescribed to reduce the risk of cardiovascular death in adults with type 2 diabetes and established cardiovascular disease.
  •  

  • Patients with heart failure may benefit from Jardiance as it helps in reducing the risk of hospitalization due to heart failure.

 

What are the side effects of Jardiance?

 

Common Side Effects of Jardiance

 

  • Urinary tract infections: Symptoms may include burning sensation while urinating and frequent urges.
  • Increased urination: This is due to Jardiance's mechanism of removing excess glucose via urine.

 

Serious Side Effects

 

  • Ketoacidosis: This rare condition might present as difficulty breathing, nausea, or confusion.
  • Dehydration: Symptoms can be dizziness or light-headedness, especially upon standing.

 

Allergic Reactions

 

  • Rash or hives can occur, requiring immediate medical attention.

 

Precautions

 

  • Consult your healthcare provider before starting if you have kidney issues or are on diuretics.

 

Can Jardiance cause weight loss?

 

Can Jardiance Cause Weight Loss?

 

  • Yes, Jardiance (empagliflozin) can lead to weight loss. This medication is primarily used to treat type 2 diabetes.
  •  

  • It works by preventing glucose reabsorption in the kidneys, leading to glucose excretion through urine, which may also result in calorie loss.
  •  

  • Clinical trials have shown weight reduction as a common side effect, often averaging 2-3 kg.
  •  

  • This loss can differ among individuals; factors like diet and exercise may influence the extent of weight change.
  •  

  • Always consult with healthcare professionals to understand the benefits and risks associated with your specific health condition.

 

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We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

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Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

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Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

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